First Name *
Last Name *
Phone number (International format) *
LinkedIn Profile URL:
Personal website / blog
Summary bio (50 words) *
Your skills and expertise (up to 10 comma separated keywords) *
e.g. telehealth, startups, events, marketing
Picture (headshot) *
Resume / bio
Have you attended an Aging2.0 event/s in the past? Which ones?
Did an existing Aging2.0 Chapter recommend you start a Chapter? If so, please list that Chapter.
What CITY would you like to start / join an Aging2.0 Chapter *
No extra text please - just name the city
What STATE (optional) and COUNTRY would you like to start / join an Aging2.0 Chapter *
Additional notes about location
Any additional comments about where you want to get involved
Why do you want to get involved with Aging2.0? *
Help us to understand your motivation and interest
Would you be willing to help organize event/s? *
What specific activities would you most like to work on?
How would you like to be involved? *
How much experience in using web-based community tools (such as Wordpress, Meetup, etc) *
What organization affiliations will you draw upon for the organization of events and the development of the local Aging2.0 network? *
Government (federal, state, local), associations, startups, industry groups, etc.
What are some ideas you have for speakers at future events? *
What do you see as the biggest challenge in growing the Aging2.0 community in your area? *
Any other information that would be helpful for us to review your application?
Values: The values of Aging2.0 are innovation, collaboration and respect for all ages. We expect all people applying for and working with Aging2.0 to uphold these values.
Policies:The minimum age to be an Ambassador is 18 years old. Please read all of the information at aging2.com/local and check the box below if you understand and agree to the policies outlined there.
Subject to change: This program is subject to change. We will communicate with you updates about the program and your participation on a regular basis.
Please confirm your acceptance of our Values and Policies *